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Lens and cataracts
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Cataract surgery involves the replacement of the diseased lens with an intraocular lens (IOL). This is achieved by: Phacoemulsification (gold standard): This technique uses an ultrasonically driven needle (phaco tip) to chop the nucleus and then aspirate the lens material.Extracapsular cataract extraction (ECCE): May be used for very hard cataracts.
Removal of intraocular foreign bodies
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
William J Wirostko, Sumit Bhatia, William F Mieler, Cathleen M McCabe
IOFBs located in the anterior chamber are best removed through a secondary limbal incision after the traumatic laceration has been repaired (Fig. 49.4). This limits the trauma to the original laceration and facilitates instrumentation. The secondary incision should be placed 90° away from the IOFB to avoid traversing instruments over the lens capsule. Additional lenticular protection is possible by inducing miosis pharmacologically. The IOFB can be engaged with either intraocular forceps or a rare-earth magnet, while viscoelastics maintain the anterior chamber. Viscoelastic dissection may be helpful for removing an IOFB from the iris. Lens extraction is usually necessary if the IOFB is embedded in the lens.31 Removing the lens in total helps to prevent dropping the IOFB into the posterior segment. If an intralenticular IOFB can be grasped, its extraction should be performed before cataract extraction. An anterior capsular laceration can often be converted into a capsulorhexis and the cataract removed by aspiration. Intraocular lens implantation can be performed concurrently, depending upon the extent of the trauma and the risk of infection.
Microsurgery in Ophthalmology
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
The use of an intraocular lens implant following cataract extraction is controversial, due to the surgical and postsurgical complications. Evidence suggests that many postoperative complications result from surgical trauma. Injury to the corneal endothelium and other parts of the eye can best be avoided with the use of the operating microscope. As intraocular implants can be defective, it is the surgeon’s responsibility to check on the quality of the implant prior to insertion (Plate 7). It is important during the placement of the loops to ensure that they are placed in the right position with minimum trauma (Plate 8). Suturing the lens is, again, best performed under the operating microscope.
Secondary Intraocular Lens Implantation (IOL) in Children- What, Why, When, and How?
Published in Seminars in Ophthalmology, 2023
Sakshi Lalwani, Ramesh Kekunnaya
Secondary IOL implantation is considered in children who previously were operated for congenital cataract extraction usually after 2 years of age when these children become intolerant to aphakic correction.1 There are numerous modalities of optical corrections available like contact lenses, spectacles, and intraocular lens implantation. Early visual rehabilitation of these children along with appropriate amblyopia management can help to improve their visual acuity and quality of life.2,3 When children and their parents are unwilling to accept glasses or contact lenses for optical correction, secondary IOL implantation can be considered. But for children who are less than 2 years of age, this can be a little challenging as one needs to consider age-appropriate under-correction, refractive outcomes considering constant eyeball growth. The initial hypermetropia after under-correction is thought to be more amblyogenic by some surgeons.4,5
Association between Increased Cataract Surgery Duration and Postoperative Outcomes
Published in Ophthalmic Epidemiology, 2023
Ashton Kalhorn, Jennifer L Patnaik, Cristos Ifantides, Cara E Capitena Young, Anne M. Lynch, Karen L Christopher
We identified 5839 surgeries that met the inclusion criteria. Of those, 768 (13.2%) were classified as long surgeries. The majority of surgeries were performed on females (59.9%) but a smaller percentage of females had long surgeries (12.0% versus 14.9% for males, p = .002). Most patients in our population were non-Hispanic white (79.5%). There were similar rates of long surgeries in all racial groups except for African-American which had a higher rate of long surgeries at 17.5% compared to the 12.7% rate among non-Hispanic whites (p = .016). The vast majority of intraocular lenses implanted were monofocal lenses (87.3%), followed by monofocal toric (6.6%) and multifocal lenses (6.1%). Monofocal toric and multifocal lenses were both more likely to be placed during a long surgery than a monofocal lens (40.6% and 17.4% for monofocal toric and multifocal as compared to 10.7% for monofocal lenses, p < .0001 and p = .0003 respectively). Surgeries which utilized intraoperative aberrometry (11.3%) and surgeries which involved femtosecond laser (11.2%) were both more likely to be a long surgery (30.1% and 27.0% respectively, p < .0001 for both). (Table 2)
Protective Effects of Nicotinamide Riboside on H2O2-induced Oxidative Damage in Lens Epithelial Cells
Published in Current Eye Research, 2021
Biting Zhou, Guangyu Zhao, Yihua Zhu, Xiaole Chen, Nanwen Zhang, Juhua Yang, Hong Lin
At present, the main treatment for cataract is surgical removal of the opaque lens and intraocular lens implantation. In developing countries, surgery is limited by many factors. In developed countries, such as the United States, cataract surgery is the most common surgery, costing approximately 3.5 USDbillion annually.3 In Australia, the incidence of age-related cataract (76%) between 1996 and 2021 is forecast to significantly exceed the population growth rate during the same period (22%).4 In both developed and developing countries, the demand for cataract surgery substantially exceeds limited public resources, leading to arapid increase in socioeconomic costs. More importantly, in most patients, cataracts cause blindness because they are not treated in atimely manner. In addition, all types of surgical interventions may result in complications, including intraocular lens capsule tear, dislocation of part of the lens nucleus into the vitreous, postoperative endophthalmitis,5 retinal detachment6 and cystic macular edema.7